Finally , it ends over the week-end ! (It has to you know ! ) . . . Every one flies back, only to come back next year to ponder “almost the same issue” all over again. (Some times the questions are left unanswered for decades ! Not getting an answer is okay , after all research is a journey towards truth but sustaining a confusion or creating new one has been a norm in recent times.)

*Sorry , If am provocative , I need to be genuine in my expression.

Coming to the topic, Aspirin is one wonder drug which made a big impact on CAD risk . We know there is something great with this cheapest and humble Dual COX blocker.The only weak point is ,it lacks the glamor quotient like that of newer antiplatelets, NOACs and their clones.

Its my perception ,big breaking research has tried to ditch this drug for quiet a while .But ,it was all too difficult to go for the kill.So these studies circumnavigate the real issue. and end up with suspicious conclusions (or Inconclusions !) always trying to hide behind sinister statistics of course with a questionable caveat !

What’s new in the topic of Primary prevention of CAD ?

Two major studies were released recently in August 2018

Both studies suggest caution for Aspirin. If Aspirin is really bad it would (and should) have buried long ago. We should be thankful even in these testing times for truth ,this humble drug is fighting back and forth .(Digoxin is another close cousin of Aspirin fighting for the existence crisis in cardiology ! )

So what is the role of Aspirin in primary prevention of CAD ?

This question doesn’t make sense in many clinical situations.

Primary and secondary prevention are defined with reference to manifest vascular event. We will not know how much of silent CAD exist in asymptomatic persons.Primary prevention of CAD itself could be a misnomer as most elderly do carry at-least some form of CVD. For example, If a patient with manifest peripheral arterial disease (PAD) and takes Aspirin , its secondary prevention for PAD but becomes primary prevention for CAD . . . isn’t ?

Final message

We know Aspirin continues to be the flag bearer of all DAPT regimen.I wish it remains a star in primary prevention as well. It looks like(for me) these studies are another attempt to pull down Aspirin in primary prevention .I think ARRIVE failed to reach the desired conclusion. Aspirin is a warrior and it will never allow that to happen and ASCEND to glory again !

Postamble

Modern drug research appears to pursue a study till the desired conclusion is reached. We need important drugs in many vital areas of cardiology .Our energy should be focused to find new molecules. It is worrying trend(if its true !) if efforts are wasted to finish off humble generic drugs with proven worthiness. Doing research in established concepts is the most silly thing to do. Its duplication of knowledge.

Counterpoint

It’s scientific blasphemy to criticise studies without analysing it in a professional manner.It appears all too brutal to take a biased view and questioning the motive of researchers. Yes agreed , I may be prejudiced , . . but , why a doctor of this caliber make a statement of this sort ?

Its a fact , there are so many true scientist doing their job right, my query is simple why we are not getting clear answer in many common issues In spite of great research ?

Is it the limitation of science or vagaries of research ? I think it’s more of a Intellectual insufficiency aided by malfunctioning regulators !

I got this alert from World health organisation yesterday .Click over the image to read more .

Why should a cardiologist affected about this ?

When we are fighting in cath lab day in night day out to extinguish the myocardial fireset by coronary thrombosis and the resultant STEMI . . . the solemn attempt to salvage whatever myocardial cells we can !

See . . . what is happening elsewhere every 40 seconds a healthy heart in toto is executed by weak minds !

What should the WHO do ?

Just publish these data and forget . No,they should organise the world leaders to take a resolve !

Either , we should prevent these unnatural deaths or else we should have world organ net work. Why can’t we use these weak hearts for those courageous men and women who lose their life daily with end stage cardiomyopathy who long for living !

Is this possible ?

Why not ? Ain’t the world leaders group together periodically to impose a sanction or bomb other countries for personal reasons !

I stumbled upon a TV reality show where a mother of a child was crying inconsolably ,whom she lost when it fell into a open bore-well pit .She was blaming it as her fate and the hole was sent by Lord Yama (God of death )

I just got curious ! This article was written in a flash.

I used to get questions from anxious parents of children with holes in the heart .(Asymptomatic small VSDs or ASDs who come for periodic echo-cardiograms) .I reassure and convey the message , most of these holes are tiny and will close automatically and they need not worry.Even if it doesn’t, it poses little problem.

But .after watching that haunting TV show, I have started to warn the parents that holes in the heart may not be that dangerous but be wary of holes in the roads and unclosed bore wells in our country !

Every single parent was amused with my statement ! Some how it appeared sense to me !

I made a mini google research. It is estimated thousands of bore-wells are dug every day and kept open in allover the country side .It is like live land mines . Some press reports suggest at least one child dies in India every day due to uncovered bore-wells and man holes ! (May be really true !)

The following are some of the samples.

One

One more

Two

You can understand the gravity of the problem , one engineer has devised a special child retrieval Robot for such accidents.

Three

A news report in Times of India .What shall we do about these ?

It is a horrific truth in this civilised world .Nature creates holes in the heart due to defective gene in some . It appears less dangerous to me. After all a hole in the heart threatens only one life,while a hole in the road kills many people.

As a cardiologist , I am saying this with anguish as our team along with surgeons work over time to close intra-cardiac holes with device , the holes in the road are often callously kept open forming death traps for our children .The men responsible for such things deserves no pardon.

The story is never ending . . .

Post-amble:

Doctors are not just the noble professional who provide relief from illness . They have other social responsibilities too !

I believe , as physicians bound by Hippocratic oath , we should help tackle issues that threaten our pubic health system , especially in this case were the victims are vulnerable children !

In fact , pediatricians should come forward to work with Govt to improve safety issues for children and orthopedicians should help prevent road traffic accident while cardiologists shall work with the Govt to prevent heart disease . . . etc etc .

Though bore-well deaths are a pan India phenomenon , One state in India ( TN) has taken a new initiative recently and has banned digging bore-wells without prior permission and stipulated strict guidelines .Others can take a cue from here !